PHILADELPHIA -- In patients with type 2 diabetes receiving intensive blood pressure treatment, the amount of visceral fat did not have an impact on cardiovascular events, a post hoc analysis of the ACCORD Blood Pressure Trial found.

There was no association between the amount of central obesity and the primary composite outcome of cardiovascular death, nonfatal myocardial infarction (MI), or nonfatal stroke in those receiving intensive blood pressure treatment (P>0.25), reported Joshua I. Barzilay, MD, from Emory University School of Medicine in Atlanta, and colleagues.

There also was no association between the amount of visceral adipose fat and the secondary outcomes of nonfatal MI, fatal or nonfatal stroke, or cardiovascular death (P>0.09), Barzilay reported here at the annual meeting of the American Diabetes Association. The study was also simultaneously published in the July issue of Diabetes Care.

The hypothesis that those in the intensive blood pressure lowering group with higher central obesity would see greater risk reduction in cardiovascular events was not borne out, Barzilay said.

However, there were trends that intense control was associated with fewer composite events, total strokes, and nonfatal MIs in the quartiles with higher waist-to-height ratios, but the between-quartile differences did not reached significance.

In a single linear covariate model where researchers controlled for waist-to-height quartile, they found that intensive blood pressure control was associated with a stroke benefit, which was similar to the results in the ACCORD Blood Pressure Trial, they said.

In the same model when they compared the first and fourth quartiles for the four outcomes, weight-to-height ratio was significantly related to cardiovascular disease mortality (hazard ratio 2.32, 95% CI 1.40 to 3.83) The P-value was 0.0009 comparing the heaviest to lightest quartiles.

Overall, however, intensive blood pressure lowering did not offer a significant protective benefit in any waist-to-height quartile. Barzilay suggested that the negative effects of diabetes are present in any amount of adipose fat, thereby overriding any potential benefit that intense blood pressure treatment might offer.

The intensive-glucose-lowering arm (to an HbA1c of <6%) of the original ACCORD (Action to Control Cardiovascular Risk in Diabetes) trial was stopped prematurely in 2008 because of a 22% excess mortality.

Two ACCORD substudies found no cardiovascular benefit for adding fenofibrates to statin therapy or for intensely lowering blood pressure.

The current post hoc study examined the 4,687 participants from the ACCORD Blood Pressure Trial substudy to determine if central obesity had an impact on cardiovascular events.

Researchers had access to waist circumference measurements, but the hip circumference was not measured in ACCORD. So they used the waist-to-height ratio instead, which "has been validated as a marker of cardiovascular disease outcomes related to central obesity," Barzilay said.

He noted that a waist-to-height ratio of less than 0.50 is associated with less cardiovascular risk than one above that level. In this analysis, the mean waist-to-height ratio was 0.60 and women had higher ratios than men.

Baseline characteristics between the those receiving intensive and conventional blood pressure treatment were similar, with the average age being 62 and two-thirds of the participants being white.

The study is limited by its post hoc nature, the modest number of outcomes (about 7% primary outcomes per year), and the short follow-up, researchers said.

The study received support from the National Heart, Lung, and Blood Institute, the National Institute of Diabetes and Digestive and Kidney Diseases, the National Institute on Aging, and the National Eye Institute. The ACCORD study received funding from the Centers for Disease Control and Prevention.